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How were you hurt?
Car Accident
What was your role in the accident?
Driver
Passenger
Pedestrian/Bicyclist
Not Involved
Slip and Fall
Dog Bite
Bicycle Accident
While Working
Other
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Who was hurt?
I was hurt
A loved one was hurt
We were both hurt
Other
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What was the date of the accident?
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Where did the accident occur?
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Was the accident your fault?
Yes
No
It was partially my fault
I'm not sure
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Not qualified
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Were you treated for your injuries?
I was treated at a hospital
I was treated at a Chiropractor's Office
Other
I was not treated
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Can you describe the injury?
Head Injury
Back/Spine Injury
Leg/Arm Injury
Broken Bones
Death
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Do you have health insurance?
Yes
No
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If involved in a car accident, do you have car insurance?
Yes
No
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Are you represented by a lawyer?
Yes
No
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Is there anything else important we should know?
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Can we get your contact email?
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About
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Personal Injury
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